Shoulder dystocia is a serious and unpredictable obstetrical complication that occurs during childbirth when the shoulders of the fetus become entrapped behind the mother's pubic bone and sacrum. It is a true obstetrical emergency requiring a rapid and effective remedy or serious injury to the mother or baby may occur. The greatest concern is the over stretching of the nerves from the fetal neck to the fetal arm (brachial plexus). Over stretching of these nerves may cause permanent nerve injury leading to paralysis of the affected limb (Erbs palsy). A variety of techniques have been described to deal with such an emergency. Most of these involve some traction on the fetal head and neck that may injure the brachial plexus.
Another technique involves delivery of the posterior arm of the fetus. Traction beneath the fetus's posterior axilla (arm pit) may assist in this maneuver by “shrugging” the baby's shoulder, reducing the anterior and posterior (front to back) diameter of the fetal shoulder girdle. This shrugging allows greater access to the posterior arm of the infant and makes easier the delivery of the posterior arm. Once this is accomplished, safe delivery of the infant is possible.
This technique has been improved by utilizing a length of catheter tubing as a traction device. In the standard methodology, the tubing is looped over the obstetrician's index finger, the looped end is inserted trans-vaginally beneath the fetus' posterior axilla, and the looped end is then transferred to the opposite index finger and pulled to create a sling under the fetus' axilla and around the shoulder. Because the tubing is slippery, the exposed ends of the tubing are then typically knotted or clamped. Traction is then applied to the sling shrugging the posterior shoulder assisting in the delivery of the fetal posterior arm.
It is an object of this invention to improve upon the manipulation technique by providing a subaxillary traction device having improved structural and functional characteristics in comparison to the length of tubing currently utilized. The traction device provides a structure that increases the ease and efficiency of transvaginal insertion and positioning of the device beneath the posterior axilla and of retrieving the inserted end of the device. The traction device further provides a handle or grip structure that enables traction to be applied using the fingers without needing to form a knot or utilize a clamp.